6
Preoperative Evaluation
对病人健康情况进行 全面评价，明确是否存在增加 手术危险性或不利恢复的因素
7
第一类病人： 耐受力良好，重要
器官无器质性病变，或功 能处于代偿状态，进行一 般准备后手术
8
第二类病人：
耐受力不良，重要器官有 器质性病变，或功能处于失代偿 状态，外科疾病对全身造成明显 影响，需作特殊准备后手术
20
Hepatic disease 急性肝炎或肝功能严重损害 的慢性肝病，一般不宜施行 手术 术前准备：增加肝糖原储备、 增强肝细胞功能、 改善凝血 状态、 纠正低蛋白血症、 消 退腹水
21
Disease of Kidney
o Maintaining renal blood flow and glomerular filtration rate
Malnutrition
Morbidity and mortality increased
16
Correcting disorder of fluids, electrolytes, acid base Supplying energy, albumin, vitamins, and correcting anemia Retaining positive balance of nitrogen metabolism
围手术期处理
Perioperative managements
1
Surgical Procedure
Therapeutic Process Traumatic Process
2
Aims
❖ 术前准备: 提高病人对手 术的耐受性
❖ 术后处理: 减少并发症， 促进康复
3
Preoperative preparations
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❖ Gastrointestinal Tract：
术前12小时禁食；4小时禁饮
Special preparation for gastrointestinal
operation
liquid diet
intestinal bacteria antibiotics,
GI tube cleaning enemaSBiblioteka ecial examinations
5
Operative Character
o Selective Operation：手术的迟早 不影响疗效，做好充分的术前准备
o Limited Operation：手术时间有一 定限度的选择，尽可能做到充分的 术前准备
o Emergency Operation：最短时间 内迅速手术，进行必要的术前准备
术前处理的几个阶段：
Clinical Diagnosis Preoperative Evaluation Preoperative Preparation
4
To make sure the diagnosis
Illness history
Physical examination
Laboratory findings
14
❖ The others: cleaning the skin of operative area temperature menstruation sedatives for good sleep cross-matching of blood urinary catheter
15
Special preparation （针对二类病人）
13
❖
Preventive infection:
无菌原则、避免院内感染、预防性应用抗菌素
1) Infected operation 2) intestinal operations 3) large operation 4) contaminated trauma 5) cancer, blood vessel operations 6) organ transplantation
o Keeping fluids, electrolyte, and acid-base balance
o Using diuretic ( mannitol ) o Avoiding use of renal impairing
drugs o Using dialysis therapy for severe
9
Preoperative Preparation
根据诊断、术前评价情 况和手术性质所采取的措施
10
General Preparation ❖ Psychological ：医务人员、
病 人及家属
11
❖ Physiological
适应术后变化的锻炼: 手术特殊体位的适应性训
练，术后床上活动、咳嗽、翻 身、排便等
renal dysfunction
22
Hypoadrenocorticism
正在应用皮质激素治疗或在6
~12月内曾用皮质激素治疗超
17
Hypertension:
Controlling blood pressure below 21.3/13 K Pa or 160/100mmHg, but not necessar to normal
Avoiding use of 1 receptor retarder (reserpine) two weeks before operation
Heart failure delayed 3-4 weeks to operation
Acute myocardial infarction delayed 6 months to operation
19
Respiratory dysfunction 阻塞性肺换气功能不全，常见 有哮喘、肺气肿 术前准备：戒烟二周，深呼吸 锻炼、 应用支气管扩张剂、雾化 吸入、应用激素、应用抗生素
18
Cardiopathy
Heart diseases with normal cardiac rhythm and without tendency of heart failure are well endured to operation
Acute myocarditis are poor tolerant to operation